The trend of self-harm incidence rates among adolescents in low- and lower-middle-income countries and its associated contextual factors.

This study examined trends in adolescent self-harm incidence rates and associated contextual factors among 77 low- and lower-middle-income countries. Annual sex-specific self-harm incidence rates for ages 10-19 years were obtained from the Global Burden of Disease 2021 database. Joinpoint regression assessed trends while country and year fixed-effects models examined their association with self-harm incidence rates. Median incidence rates declined from 35.9 to 35.3 per 100,000 among males and from 40.8 to 38.1 among females. Average annual percentage changes (AAPCs) among males were negative in 40 countries and positive in 37 (maximum 2.16%); among females, AAPCs were negative in 47 and positive in 30 (maximum 3.64%). Male self-harm incidence rates were positively associated with drug use exposure, adolescent fertility, new HIV infections, rule of law and unemployment, and negatively with control of corruption, alcohol use and urban population. Female incidence rates were positively associated with adolescent fertility rates, drug use, rule of law, mean years of schooling and labor force participation, and negatively with alcohol and tobacco use exposure, control of corruption, regulatory quality and sociodemographic index. These sex-specific differences in trends and contextual factors emphasize the need for integrated reproductive, mental and substance use targeted country-level prevention strategies.